Sorry To Upset You, But....

suebird3 · Oct 2, 2005

LTC nurses are unbelievably stressed due to unrealistic workloads from management, in addition to typically being micromanaged by an administration that has no idea what nurses do all day (or night).
Things work differently in LTC. The admission that's streamlined and takes about 45 minutes in a hospital will take a LTC nurse about 3 hours. No kidding. It's about 30 pages of paperwork and complicated assessments because the liability in NHs nowadays is so great that they're CYA'ing to the point of ludicrousness (is that a word?). That's done in between med passes (3 hours apiece) and Medicaid charting (another few hours), treatments and dressings (about 2 more hours). Oh, and it could take DAYS for the attending to call back to verify or change orders, especially for patients transferring on weekends.
Add to the mix that there are frequently nonstop phone calls from disgruntled relatives, emergencies in which the doc doesn't call back for days, stat labs that take 36-48 hours to get results....
well, you get the picture.
I'm thinking that the nurse you spoke with was burned beyond recognition and probably needs to quit LTC but can't because hospitals won't take LPNs and HHC is not much better.
Next time, you might include a short written report and let all that other stuff just slide right off.:icon_hug:

Angie.....I always remember that "This, too, shall pass." You have written exactly what I have seen, and I do what I can when I can.

When I went onto the present round of 11-7's, I collared the one "hard to get ahold of" MD's, and negotiated for some ground rules. :chuckle He was pretty cool about it.

lisa41rn · Oct 2, 2005

Wish I knew the answers to all the questions!! One thing I see a lot is the elderly skin is soooo fragile. IV sites are covered with so much tape and then taking the tape off nearly tears their skin. The longer they're in the hospital, the more IV sites are started (they need to be replaced every three days), leaving a lot of bruises much of the time. Foleys are terrible as well. That darn tubing rubs on their skin. You can again tape down part of it, but not all of it. But again, your using tape on the fragile skin. As much as I reposition patients, I'm sure it's just not being done as much as it should by all nurses. I really pay attention to the heels, but sometimes I'll DC a patient and am not impressed by the patient's skin condition. Also, with the antibiotics they are often on, they are in Attends and end up with a nasty rash from being incontinent so much.

I'm not one for excuses, but time is limited for ALL of us. Wouldn't it be nice to always have a good notice to prepare for patients? Sometimes I ask why I got into such a stressful, overworked, sometimes underappreciated career, but I always look back at some of the patients who DID appreciate what I've done for them and it makes it worth it. We all need to stick together!!

sjb2005 · Oct 2, 2005

I too would question what the heck happened while my resident was at the hospital. I can only say...since I've been there done that...I have a respect for both types of nurses.

ktwlpn, LPN · Oct 2, 2005

. We all need to stick together!!

YES-Instead of b*tching and moaning...Let's lift each other up instead of trying to tear each other down....I'm a full time float nurse and work with all types...Everyone knows my philosophy-When I'm at work I have my "game face" On....Even if I don't feel 100% on any given day I try to put a calm smile in my voice and on my face and usually by mid-moring that is really how I feel...I get paid to be polite and professional-and that includes with co-workers from all depts-not just residents and their families..And I don't mean I am the Queen of Warm fuzzies,either--you can be "nice" without going over-board...I try to pay attention to my tone of voice and body language,too...I have had my bad days-don't get me wrong...But-without fail -when the dust clears I go back and apologize... if I had a nickel for every time some miserable person said to me " I'd like to take some of what you are on" I'd be a rich woman....I'll admit that my anti-depressants are nicely fine tuned at the moment...but I have always tried to present a positive attitude and I love what I do...If I didn't I'd look elsewhere....

Daytonite, BSN, RN · Oct 2, 2005

As you are probably aware, the social service people and any others involved in the discharge of a patient from acute care hospitals make arrangements with the nursing homes for transfer of the patient. They first have to contact the administrators or the admission co-ordinator at the LTC facility. Calls are then put out to the patient's family to get the financial things taken care of. The staff nurses in LTC are the last to hear about an admission. LTC's handle the actual admission differently too. Some have an admission nurse who takes care of calling the MD for orders as well as speaking with a nurse at the hospital. I've known of LTCs that have someone go to the hospital to evaluate a patient before accepting them at their facility. In other LTCs the DON walks up to a charge nurse and says "we're getting an admission today" and the patient shows up 15 minutes later and the charge nurse is responsible for getting everything taken care of for the patient. When someone gets huffy like you've described there are a couple of things I'll do depending on how busy I am or what kind of mood I'm in: (1) I don't say anything and let the nurse go on ranting. I don't give report until she finally says something like, "well, are you going to give me report?" (2) just keep talking over the other nurses ranting as if I don't even hear her. If she asks for repeated information I just tell her that if she had been listening instead of complaining I wouldn't have to repeat yourself, (3) put the phone down on the desk or just hang up on her and walk away, or (4) stop the nurse and tell her to call me back when she's ready for report and hang up on her. I'll then call back 5 or 10 minutes later and ask for the DON or another nurse to give report to. If they ask why I hung up or ignored them I say that the nurse insisted on complaining to me about how the nursing home was dumping a patient on her, she wouldn't let me give her a report, and I had other things I had to do. The problem is with the communication in this nurses LTC, not with you. I can't tell you how many times I got admissions from the acute hospital without one call from a hospital nurse giving me report.

unknown99, BSN, RN · Oct 3, 2005

I have been out of LTC for 6 years now, and into the hospital. I have to say I will never go back to LTC for many, many of the reasons in these posts. I take my hat off to nurses who do it, because caring for upwards of 25 to 50 patients at a time is at best, excrutiatingly difficult. You LTC nurses are a special group, and deserve praise for all you do. I have been there, did that for 20 years, and cannot do it anymore.

Really An Actress · Oct 3, 2005

There are two reasons an LTC nurse is asked if their patient is DNR: the first reason is eventually we all die, and the receiving nurse would like to know the patients' wishes in the event a decision must be made about how to treat. It is never a matter of not treating the patient, it is a matter of complying with the patient or family wishes. Even if the patient is not critical at the time of transfer, we all know that people can take a turn for the worse at any time. The receiving nurse would like to be prepared and this is a very relevant question.

Something else I would like to mention, and I realize this may make LTC nurses defensive, it that frequently patients are sent to the hospital for illnesses or injuries that can be taken care of in the LTC. I've often called report to a nurse about her returning patient that has a head laceration, a normal hip Xray, etc. only to hear that nurse screech, "You mean you're just going to send them back to us?" Yes, I am. Most transfers, at least at my hospital, do not require an admission. I don't know why some LTC nurses assume this.

And I wish health care providers for LTC residents would think twice before shipping them via ambulance for minor injuries when the outside temperatures are either extremely cold or extremely hot. I'm already dreading the winter when LTC patients will come to the ER for a minor fall, for example, against their wishes when it's 10 degrees outside and the middle of the night. I see competent elderly people bewildered and angry that they've been dragged to the ER against their will.

Now let me say in favor of LTC nurses that I realize usualy transfers are not your choice. Many times family is notified of a resident's change in condition and the family, or the doctor who knows the family, will insist the patient be sent to the ER rather be treated at the facility. In this case the nurse can only comply. I offer my sympathy for these nurses in such situations. And usually most nurses call and give a clear report and send all the necessary paperwork. Every so often, though, the only information we know about a patient is the brief report given to us by paramedics because a nurse has not called report. If the patient has dementia or is unable to communicate, we end up doing a full work-up that is often unnecessary. I also know that some doctors are just lazy and it's easier for them to have ED docs see the patient than actually provide the care for which they're being paid.

Bird2 · Oct 3, 2005

There are two reasons an LTC nurse is asked if their patient is DNR: the first reason is eventually we all die, and the receiving nurse would like to know the patients' wishes in the event a decision must be made about how to treat. It is never a matter of not treating the patient, it is a matter of complying with the patient or family wishes. Even if the patient is not critical at the time of transfer, we all know that people can take a turn for the worse at any time. The receiving nurse would like to be prepared and this is a very relevant question.
Something else I would like to mention, and I realize this may make LTC nurses defensive, it that frequently patients are sent to the hospital for illnesses or injuries that can be taken care of in the LTC. I've often called report to a nurse about her returning patient that has a head laceration, a normal hip Xray, etc. only to hear that nurse screech, "You mean you're just going to send them back to us?" Yes, I am. Most transfers, at least at my hospital, do not require an admission. I don't know why some LTC nurses assume this.
And I wish health care providers for LTC residents would think twice before shipping them via ambulance for minor injuries when the outside temperatures are either extremely cold or extremely hot. I'm already dreading the winter when LTC patients will come to the ER for a minor fall, for example, against their wishes when it's 10 degrees outside and the middle of the night. I see competent elderly people bewildered and angry that they've been dragged to the ER against their will.
Now let me say in favor of LTC nurses that I realize usualy transfers are not your choice. Many times family is notified of a resident's change in condition and the family, or the doctor who knows the family, will insist the patient be sent to the ER rather be treated at the facility. In this case the nurse can only comply. I offer my sympathy for these nurses in such situations. And usually most nurses call and give a clear report and send all the necessary paperwork. Every so often, though, the only information we know about a patient is the brief report given to us by paramedics because a nurse has not called report. If the patient has dementia or is unable to communicate, we end up doing a full work-up that is often unnecessary. I also know that some doctors are just lazy and it's easier for them to have ED docs see the patient than actually provide the care for which they're being paid.

Thanks for recognizing that at times we don't have a choice but to send a resident to ER when we know that we should not have to. I can not count the times that I have called for an antibiotic order or to report that someone fell but has no injuries and the MD says " Send to ER." and hangs up. It is embarrassing and a lot of paper work. Clear, consise reports to the MD and ER are imperative. I have truly seen wonderful and obnoxious nurses in each field. Hopefully all nurses will eventually realize that all nursing jobs are tough.

CoffeeRTC, BSN, RN · Oct 3, 2005

There are two reasons an LTC nurse is asked if their patient is DNR: the first reason is eventually we all die, and the receiving nurse would like to know the patients' wishes in the event a decision must be made about how to treat. It is never a matter of not treating the patient, it is a matter of complying with the patient or family wishes. Even if the patient is not critical at the time of transfer, we all know that people can take a turn for the worse at any time. The receiving nurse would like to be prepared and this is a very relevant question.
Something else I would like to mention, and I realize this may make LTC nurses defensive, it that frequently patients are sent to the hospital for illnesses or injuries that can be taken care of in the LTC. I've often called report to a nurse about her returning patient that has a head laceration, a normal hip Xray, etc. only to hear that nurse screech, "You mean you're just going to send them back to us?" Yes, I am. Most transfers, at least at my hospital, do not require an admission. I don't know why some LTC nurses assume this.
And I wish health care providers for LTC residents would think twice before shipping them via ambulance for minor injuries when the outside temperatures are either extremely cold or extremely hot. I'm already dreading the winter when LTC patients will come to the ER for a minor fall, for example, against their wishes when it's 10 degrees outside and the middle of the night. I see competent elderly people bewildered and angry that they've been dragged to the ER against their will.
Now let me say in favor of LTC nurses that I realize usualy transfers are not your choice. Many times family is notified of a resident's change in condition and the family, or the doctor who knows the family, will insist the patient be sent to the ER rather be treated at the facility. In this case the nurse can only comply. I offer my sympathy for these nurses in such situations. And usually most nurses call and give a clear report and send all the necessary paperwork. Every so often, though, the only information we know about a patient is the brief report given to us by paramedics because a nurse has not called report. If the patient has dementia or is unable to communicate, we end up doing a full work-up that is often unnecessary. I also know that some doctors are just lazy and it's easier for them to have ED docs see the patient than actually provide the care for which they're being paid.

I totally see your side on this. As far as sending residents out and then stating....your sending them back, so soon. My biggest beef with this is that we never get paper work with them. For example, I send them out with a fall and head laceration or c/o ankle, hip pain, etc. ER nurse tells me they did an xray, whole work up etc....Could I please have a copy of these results or at least a doc writting this. The only reason I really need this is to prove( to the state, because they will be in the next day all over us, that I did indeed seek treatment. What I'm trying to get at is that most transfers to the hospital in those type of incidents are major CYA. Major PITA too.

As far as sending minor falls etc against a resident wishes....major no, no but I bet they are just CYA too. Remember, Most LTCs dont' have a doc or NP in house and in our facility the docs only round once a week or so.

dinkymouse · Oct 4, 2005

In our area both hospitals fax over the discharge information as soon as they get it. This gives us time to order meds and things. They also call and give us a verbal report.